评估基于索赔的精神病性和情感性障碍诊断编码的有效性以及台湾全民健康保险研究数据库中从国际疾病分类第九版（ICD-9）到国际疾病分类第十版（ICD-10）编码转换的影响。
Assessing the Validity of Claims-Based Diagnostic Codes for Psychotic and Affective Disorders and the Influence of the Coding Transition from the ICD-9 to the ICD-10 in Taiwan's National Health Insurance Research Database.
作者信息
Wang Yen-Wen, Liu Chen-Chung, Chen Hsi-Chung, Wu Chi-Shin, Chan Jen-Hui, Chen Cheng-Che, Huang Wei-Lieh, Liao Shih-Cheng, Hwang Tzung-Jeng, Chen Wei J
机构信息
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
出版信息
Clin Epidemiol. 2025 Jul 10;17:635-645. doi: 10.2147/CLEP.S522618. eCollection 2025.
PURPOSE
No studies have validated psychiatric diseases diagnoses in Taiwan's National Health Insurance Research Database (NHIRD). We aimed to assess the interrater reliability of chart-review among psychiatrists, examine the validity of the diagnostic codes for psychotic disorders and affective diseases in the NHIRD against review-based diagnoses, and examine whether the change in the coding system from the ICD-9-CM to the ICD-10-CM affected the validity of the diagnostic codes.
PATIENTS AND METHODS
The study participants were psychiatric inpatients aged 18 to 65 years who were admitted in 2015 and 2017, respectively, to the main and three branch hospitals of National Taiwan University Hospital. A chart review was conducted among 48 purposively selected inpatients with discharge diagnoses in five core categories to assess interrater reliability. This chart-review procedure was then used to generate diagnostic codes for a stratified sampling of 727 inpatients with discharge diagnoses in 12 diagnostic categories of psychotic disorders and affective disorders to examine the validity of the diagnostic codes.
RESULTS
The intraclass correlation coefficient reliability of schizophrenia and three broad categories of diagnoses indicated good interrater reliability. The positive predictive value and sensitivity of common diagnoses in the narrow category (eg, schizophrenia) or the broad category (eg, psychotic disorders, bipolar disorders, and major depressive disorders) were high-performing (≥ 0.70), whereas those of the diagnoses of low prevalence were modest. The validity indices of claims-based diagnoses using the ICD-10-CM tended to be better than those using the ICD-9-CM.
CONCLUSION
This first-ever study validating psychiatric diagnoses in Taiwan's NHIRD using a structured chart review suggests that the diagnostic codes of narrow categories of schizophrenia or other broad categories are recommended for high-performing validity indices. Intensive training for the coding plus the specific details requested by the ICD-10 may increase the validity of the claims-based databases for psychotic and affective disorders.
目的
尚无研究验证台湾地区国民健康保险研究数据库（NHIRD）中精神疾病诊断的准确性。我们旨在评估精神科医生之间病历审查的评分者间信度，对照基于审查的诊断，检验NHIRD中精神障碍和情感性疾病诊断编码的有效性，并考察编码系统从国际疾病分类第九版临床修订本（ICD-9-CM）转换为国际疾病分类第十版临床修订本（ICD-10-CM）是否影响诊断编码的有效性。
患者与方法
研究参与者为分别于2015年和2017年入住台湾大学附属医院总院及三家分院的18至65岁精神科住院患者。对48名经目的性选择、出院诊断涵盖五个核心类别的住院患者进行病历审查，以评估评分者间信度。然后采用该病历审查程序，为727名出院诊断涵盖精神障碍和情感障碍12个诊断类别的住院患者分层抽样生成诊断编码，以检验诊断编码的有效性。
结果
精神分裂症及三大类诊断的组内相关系数信度表明评分者间信度良好。狭义类别（如精神分裂症）或广义类别（如精神障碍、双相情感障碍和重度抑郁症）中常见诊断的阳性预测值和敏感性表现良好（≥0.70），而患病率较低的诊断的阳性预测值和敏感性则一般。使用ICD-10-CM的基于理赔诊断的有效性指标往往优于使用ICD-9-CM的指标。
结论
这项首次使用结构化病历审查验证台湾地区NHIRD中精神疾病诊断的研究表明，对于有效性指标表现良好的情况，建议使用精神分裂症狭义类别或其他广义类别的诊断编码。针对编码的强化培训以及ICD-10要求的具体细节可能会提高基于理赔的精神障碍和情感障碍数据库的有效性。
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